Does anyone have some thoughts on how to tell the difference between a muscle or tendon injury around one hip from a bone metastasis on that hip?
Aside from mPCa I've been quite healthy and this is a surprise developing over just two weeks.
My circumstances are that I am coming up to 2 years diagnosis of high-volume metastatic PCa. And thanks to triplet therapy I am doing extremely well. I'm also doing a lot of exercise, up to 10 hours a week of brisk walking balanced with careful strength training with stretchy bands and dumbbells.
About 2 weeks ago my right hip started to get sore. When I'm standing up I don't feel it. It seems to be related to certain movements. And if I palpate the hip area I think I notice some tenderness. (I do not have much of a history of sports or work injury related to muscles or tendons.)
But the whole thing is hard to describe. Certain movements are very painful. And I was woken up from sleep last for the first time by the pain. I guess I rolled my body over or something.
My sense is that this could be muscular. But I really don't know. And even reading articles has oddly not very helpful in learning how to distinguish mets pain from tissue injury pain. (Even mets pain apparently could be of different types, including a dull persistent pain just because of the met, or a sharp movement related pain because the bone is stressed and at fracture risk.)
I am familiar with mets pain because my original diagnosis was from 6 months of growing back pain due to mets in my ribs and vertebrae. But that experience was also confused with pain from nerve and cord compression.
I would be grateful for any suggestions on distinguishing between mets and tissue injury pain. My doctor would be willing to prescribe an x-ray, but my understanding is that x-rays are not very helpful for mets.
Thanks for any insights!
* UPDATE Spring '24 - It was muscle! 🤪❤️😃🎉
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JohnInTheMiddle
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My understanding, solely from reading, is metastasis pain is a dull continuous pain...in the beginning...that doesn't change with one's body position. I'd take a pain reliever, anti inflammatory meds for a week and see what happens. If it goes away, you know the answer, if not then get an X-ray and eventually an MRI if the X-ray shows nothing.
Good idea MoonRocket. In fact my wife already suggested taking an acetaminophen, instead of the leftover hydromorphone from before. I think the step by step is the right approach. And as for MRIs they are great but I'm not sure how fast one could get one in Canada.What bothers me is if either because of (1) actual tissue damage or (2) because of pain or (3) because of the risk of making tissue damage worse or (4) the possibility that it is not tissue related and that the pain is related to fracture risk - that I would have to curtail my exercise regime. In case you saw my recent post here I'm very enthusiastic to maintain a high volume of exercise - on the theory that this supports an inhospitable environment for metastatic prostate cancer progression.
I'm familiar with the myokine theory....If your able and have one available, try a rowing machine for cardio, it'll take the pressure off the hip, strengthen your entire body and, believe it or not, help maintain bone density that we are all so conscious.
If you can, switch to Aleve . 2 pills a day.
I recently went hiking in the Dolomites ( Italy) for 5 days straight on the Alta Vista 1 (avg 8 miles per day with a 35lb pack). The Aleve allowed me to get through days 3,4 and 5.
I also have a right hip night pain mystery so I take two PM x strength tylenol before bed and if it stirs me in the night I take two regular extra strength tylenol - it goes away and I sleep more. No pain during the day. Sometimes I alternate with Aleve. I do regular exercise in that area so for me I think it's muscular or arthritis, not cancer.
Don't exercise too much. I am getting pain like you when I brush my teeth leaning over the sink.
Could you stop exercising for one week and take some pain medication? I personally take one aspirin and my pain goes away. I also had problem sleeping.
No statins. I was thinking about it and there's a lot of interesting work about how it could help with PCa. But decided against it.As for taking a break that's what I'm being forced to do right now. And I'm thinking that maybe I'm healing up a bit. I want to consult with the physiotherapist as to whether the exercises I was doing contributed to this.
Part of my challenge around this is my enthusiasm and success with a high volume of exercise. As I wrote in my other big note I'm pursuing a high volume of exercise plan - on the theory that if you keep the blood serum levels of all these fantastic myokines and other things that you get when you exercise - that you will be continuously suppressing metastases. So I'm not that enthusiastic to stop exercising.
But I don't want to damage my body either. And thus I conclude that fighting cancer is like walking a tightrope. It's really important to stay on the tightrope and not fall off.
I don't think you have it quite right or at least not for all situations. I have substantial bone mets as shown by very recent PET CT scan that I was wondering about for a while. I have had pain in the exact area for months and was concerned that it might be bone pain. I have experienced pain of many sorts and thought it seems just like pain from other mets. I had done nothing (no recent falls) to injur tha shoulder and the mets are on both the scapula and the clavical not likely to be injured at the same time ?
The pain was position dependent. It took a lot of effort to find a somewhat more comfortable position when trying to sleep. Also it responded to anti inflammatory drugs. It was explained to me that bone disease can produce inflammation which then causes pain. I have to stop NSAIDs because of a biopsy happening soon and the pain comes back if I don't take more morphine than usual.
I remember asking, "what does bone pain feel like"? The MO responded its always there, if pain goes away twisting, bending, etc, its not bone pain
I was told the same but it wasn't true for me. Pre-diagnosis I had sternum pain that would be aggravated by exercise, vary day to day and respond to naproxen. Once diagnosed the CT scan revealed that my entire sternum was one big met.
Before my diagnosis, and developing from a dull back ache in the middle of my back, too very strong pain because of the beginnings of pressure on this spinal cord and mets around my ribs, a crazy time.
And extra confusing because I had covid at one point too. All kinds of pains around my chest and torso.
Here's a crazy thing I did. I thought it was better than lying on the floor trying to sleep. Maybe if I wrap myself up tight, "that will hold my body together". So I folded a full size sheet lengthwise so that it was now a long strip of cotton about 2 ft wide. Like a giant 8' bandage. And and so in the middle of the night, when everyone else was sleeping, I jammed one end in the door so that was held tight there. And then all by myself I quietly I wrapped the other end around my torso with the other end of the sheet bandage tight to the door.
And then I wound it around my body nice and tight. I think it was two or three turnings. I tried that for a while, maybe a day, and after a while I gave up. It was uncomfortably warm, among other things. From the placebo effect I thought maybe this is helping 😂. But it wasn't.
I think like the other two contributors, doctors told my dad that bone metastases are a constant pain. He is in a very similar situation to yours. Diagnosed last summer with a PSA of 130 and wide spread bone metastases, high volume. GS 8. Started triplet therapy, PSA after the last docetaxel cycle was 0.1, then still declining to a current value of 0.05. Next week he will have his first pelvic MRI since March. He told me he is very anxious about it and has a bad feeling about it, because he has severe lower back and hip pain when waking up during the night. During daytime he has no issues currently, so I think it just may be some stiffness related to his age. But of course one never knows...
May I ask why you don't take any antioxidants?
Sorry for my bad English, it's not my first language.
A big success for your dad Kenny. And as for antioxidants I took them through the '80s and '90s and in retrospect along with some other supplements I have the feeling it might have contributed to the development of prostate cancer. I don't have the research to hand but I stopped taking them because there's some evidence that antioxidants have a role in keeping one healthy. Don't quote me on this but my recollection is that the body uses antioxidants among other things to fight cancer! Because apparently little tiny cancers are developing all the time in the body; it's just part of life. And the body does a good job of cleaning up this garbage. And one way this clean up happens is that rogue cancer cells are burned up with oxidants. This is my lay person's narrative - it would be great for someone who's more familiar with the whole thing could confirm or not this summary. (I don't take vitamin E anymore either.) Does this position resonate with you?
I think there are big differences between supplements and antioxidants obtained through diet. For example, eating tomato paste (or ketchup, tomato soup, cooked tomatoes) has pretty clear benefit for some. Lycopene supplements have mixed findings with some studies suggesting they can make things worse. Vitamin e is best avoided as a supplement too. There is also pretty promising evidence for green tea but you have to be cautious with supplements as some have high doses that can cause liver damage.
My previous note was only referring to antioxidants. I do drink lots of green tea, for the catechins! And I have sliced and microwaved tomatoes everyday in a bowl for the lycopene. I do neither of these for the antioxidants - rather for their other apparent intrinsic properties against cancer. As for the risks of liver damage though, this is a very important point. Are there supplements that you are worried about where liver damage is concerned?
Some green tea supplements can be bad for your liver - some contain powdered green tea and are too strong and insufficiently regulated. Best to drink the actual tea...
kennycool, Greetings, please tell us your Dad's bio and post it in his bio section which will be helping him and helping us. All info is voluntary. Thank you in your first language!!!
So my glutes are prone to over use injuries and your weird positional issues match my experiences. I'd suggest seeing a sports physio or myotherapist who will be able to work out if it is a muscle or tendon attachment issue. Cheaper than an MRI and if they detect an issue then they will treat it in the session.
Consider to request a MRI of the hip. You may have a tear of the labrum which may cause pain when the leg is moved in different directions depending where the tear is located. . The MRI could also identified mets, tendon lesions etc..
Have you run an alkaline phosphatase test and compared to prior results?
Try stretching the glutes, piriformis, quads and hip flexors. I like the pigeon pose. Go slow on the hip flexors. Try Diclofenac (Costco) topical and see if you get relief.
I get it on one side if I run too much and don’t stretch as above.
ALP test is a good idea and in fact I had a full-on blood panel just a week before all this happened. This was the panel which provided additional evidence for my suspicion of having eaten way to low protein. Then I started exercising again. And then I had to stop. Your note that you have a vulnerability on one side is interesting.
This may be out in left field, but I had a nasty bout of bursitis in one hip a few years ago that caused quite a bit of pain. Maybe worth checking out? Good luck.
This is a very good idea HW - in fact I had forgotten I had bursitis some years ago which completely went away. One should keep a diary! In fact this was quite a big deal for a few years and was one of the same that led us to a low-carb diet!
Perhaps more infield than left, I’d say. I had a very similar experience as described by JITM and it turned out to be a combination of joint inflammation along bursitis and just a bit of arthritis too. Steroid injection cleared the joint inflammation and acupuncture took care of the bursitis.
Good idea! Under Canada's Province of Ontario's "OHIP" socialized healthcare plan I enjoy triplet therapy without paying anything out of pocket. And often excellent doctors such as at Toronto's renowned Princess Margaret Hospital. However there is probably zero chance of getting a PSMA PET scan for have perceived worry about metastasis related progression. Apparently one can pay for that but it's not an option for us..
Having very similar pain in hip area that started a week ago. It is relieved with Advil, but most severe after a few hours in bed at night. Finished last round of Pluvicto about 12 weeks ago with 97% reduction in PSA. Had CT scan a few days ago and MO says nothing there. PSMA Pet a few months ago showed nothing in that area. I may ask for a MRI of the area if it does not resolve shortly. Not sure if it is related in any way to my treatment.
Hope you find some answers. If I find out any other information, I will follow up with you.
If you have any questions do not hesitate to reach out.
I had a very similar experience about 2 years post Dx with triplet therapy. It turned out to be a combination of joint inflammation along with bursitis and just a bit of arthritis too. Steroid injection cleared the joint inflammation and acupuncture took care of the bursitis. The orthopedic Dr. wanted an MRI first to make sure it wasn’t met related pain & GREAT NEWS it revealed a marked decrease in bone met lesions in the pelvic area!
My experience does not include bone mets, but I have experienced many lymph node mets. I can tell if a met is a met rather than a muscle pain by drinking V8 or tomato juice. You should realize that a met is a tumor that has grown to a certain size, and it causes pain when it grows and puts pressure on nerves. I drink V8 juice every morning and what that does is it causes your body to increase T cells which attack tumors and thereby cause them to temporarily stop growing. Drink several times throughout the day and the tumors will actually shrink. Therefore, as the V8 juice gets through your stomach into the small intestine, it begins to cause the tumor pain to alleviate, even vanish. That is roughly a half hour after consumption, lasting for roughly six hours, as the body absorbs all the lycopenes. So that is one way to tell if it is a met, simply by the absense of pain after lycopene consumption. It works for me, but I cannot say for you, so just try it, you may like it. Oh, almost forgot, eat something with oil at the same time, as the lycopenes are not absorbed unless in oil...a few potato chips, or a few drops of vegetable oil in a small glass of V8 will do.
First drinking V8 juice in the morning every morning - for the lycopene! Because of all the reading that is available on lycopene I'm eating two while microwaved diced tomatoes every morning. I've been looking at relative expense of two tomatoes versus two lycopene pills. Now I can also compare a glass of V8 and the relative cost of lycopene! (Good reminder though to eat some fat or oil with the campaign to assist with absorption!)
Now as for your comment about being able to tell if mets are active or not, this is crazy wonderful. I'm also of the opinion that one can tell when mets are active. But as far as I can tell there's no research on this and it's pretty woo 😃. So it was very cool to see your comment on this.
Well if you buy a 64 oz bottle of V8 juice and it costs $6, and you drink 8 oz per day, that is eight servings for $.75 each. Lycopene pills, 20 mg, cost roughly $.10 each. Tomatoes cost at least $1 per pound unless you grow them yourself. So the pills are cheapest, but then is a pill the same as the fruit? I use pills mixed with fried foods, on top of V8. I grow tomatoes and use them in cooking, spaghetti and chili. The more the better, you cannot overdose.
Fantastic calculations NS. Have you worked out the costs per bioavailable lycopene as well? The fact that you can grow your own tomatoes, which implies that you would have enough space and healthy soil to do this, sounds idyllic.So it seems that you have researched supplements in particular lycopene. Your comment that you can't overdose on lycopene is intriguing. Earlier you commented on T cell-activation. Can you elaborate more on the "power of lycopene"? 😃
Well of course the power of lycopene is spread all over the internet, you just need to search. I was first aware of it after reading about a study in Japan in which:
"In one clinical trial, men with prostate cancer were given 30 milligrams daily of lycopene supplements for three weeks before prostate surgery. At the end of three weeks, those men had smaller tumors than the men who did not get lycopene, suggesting that lycopene may indeed be helpful in the treatment of already existing prostate cancer."
I put 2+2 together to get 4 and figured that if those guys took one serving per day, if you take more than once a day, you get not just tumors that grow slower, but tumors that shrink! Well, in theory, at least. So I tried taking 2, 3, 4 times per day, and my metastases gradually vanished. I kid you not. However, it seems that worked only while on Lupron.
I find all kinds of foods that are tomato based, like catsup, shrimp cocktail sauce, taco sauce, as well as tomato sauce, chili, etc. They're my way of life.
I was having hip pain and you always think the worse. X-rays CT scan with contrast and nothing. But my fever said otherwise.
Was admitted to hospital.
Orthopedic doctor came in and said no issues with my hip. An infectious disease doctor put me on an IV drip of a form of Cephalexin. And in just one day things really improved 5 days the issue was gone.
The conclusion was the joint wasn’t infected. The connecting tissue and cartilage had a bacterial infection.
The pain was horrific when I tried to lift my leg to push in the clutch on my truck. Other than that only a pain level of 2 or 3.
So I suggest a good surveillance of the body temperature just incase of a bacterial issue.
I have a similar issue. My hip met causes muscular pain with certain movements and when massaging the area. It’s a quick sharp pain that quickly stops when the movement and massage ends. I know it’s connected to a met because the scans have confirmed a large met in the area. Thankfully for me it doesn’t hinder my mobility.
I don’t have a cure for you. I’ve tried all the over the counter pain and anti inflammatory drugs. Nothing touch it. It just sucks.
Can you obtain medical cannabis where you are? I find a high CBD low THC combination with aspirin (or naproxen on a bad day) is a massive help. Before adding in the cannabis I'd find that naproxen took the edge off but only just - in combination they seem to work a treat. Also I know I'm not a mouse, but there is this paper: mdpi.com/1422-0067/21/17/6265
Lots of good advice about trying to judge the difference while you wait for what you really need. Since you are diagnosed metastatic, your oncologist or radiologist should be scheduling you for followup CT and bone scans (a bone scan should reveal anything happening on the hip). We're in Canada, too. Depending on your location, a scan might take a while if it's not considered urgent; however, your cancer centre should have the capacity to triage your request if they think it's an impending threat or if you are in unrelievable pain. Frankly, I'm surprised that, after two years, you have not had a followup. An x-ray might reveal something.
Great note MiaAmia - in fact I've had since diagnosis 18 months ago two big follow-ups so far. Bone density scans were actually great. And the cancer related scans were by CT SPECT. An x-ray and ultrasound are approved and I'll probably be able to go in early this coming week.
Your comments are good, sort of hinting at or implying all the impacts of strong pain: the uncertainty of not knowing what the problem is, the need for a diagnosis, and the delays and logistics of getting a diagnosis, all the while putting up with the pain. And the practical impact against normal daily activities. And even ones thinking might become less focused. I know there's lots of literature on this. And some people have it much worse.
So sorry you're having this problem. I'm following all these comments with interest having just posted about my husband's similar unexplained pain. Take care!
I am on my 10th year fighting bone Mets. Last month I had hip pains. The previous time was 2 years ago. Both times my Onc did a bone scan. Both times it was active cancer in the hip. I underwent radiation to treat it. You need to get a bone scan to satisfy your curiosity.good luck.
Fantastic comments here from so many people. I'm just adding my own reply on the topic of "thinking". Sometimes thinking clearly is hard. And it's work too. And it takes time to figure things out.
I have a requisition for scans and I have a physiotherapist that I can make an appointment for. And I'm taking some acetaminophen (I have some leftover hydromorphone if necessary). And I know lots of people have much worse pain than this; but as we know pain can be very distracting.
Okay I need to toughen up a little bit and make the appointments. (Other family members are also swamped for different reasons.)
Managing cancer is like walking a tightrope. One has to work hard to keep one's balance while moving forward - because if you fall off the tightrope, "one thing leads to another". My current goal is maintain my volume of exercise, while we figure out what's going on with my hip or glutes or whatever. (Along with being a husband and a Dad!)
Uh, because you can't just go and get a CT scan of the area? See my note about being on triplet therapy with socialized medicine in Ontario Canada. Very good healthcare service. But the downside is you can't just go and willy-nilly get a CT scan. Or an MRI. I've had them. But for this we're going to start with ultrasound and x-ray. Probably this coming week.If as I suspect this whole thing is soft tissue related then this will be fine. I'm hoping. If the pain continues though, and the ultrasound and x-ray were not helpful, and the doctor thinks it could be something worse, then a CT scan with dye will be forthcoming quickly. (My understanding is if it's just a single met that's popped up then radiation would be the order of the day. And then Life goes on.)
Hi Just a reminder and it is happening to me as i should be exercising a lot more just like you .
Since being on the hormone therapy it has weakened the muscles and slightly affected the bones. So i have a little weakness in the hip area and possible busitis This is due i guess not enoughh strength and support in this area.I do get my wife to stretch my legs and i try and get in the hydro therapy pool.Best wishes
I haven't had mets so I don't know what they're like. But I have had hip pain that comes and goes. This is on the outside of the hip. Anything in the groin area is likely to be OA. It's between the top of the thigh bone and the hip protrusion. There's a 2-3 inch gap that you can feel with your fingers. I've found that using a roller on this causes an immediate reduction in discomfort. I lower my hip down onto a foam roller and move backwards and forwards over the area until I find just the right point then work on that. It's worth a go.
what is the status of your psa value? I heard dr. Schulz said in one of his videos “ if your psa is undetectable, then it most likely not from cancer”.
Undetectable 😀 - your comment is a simple comment but it's a good comment - because the underlying fear is that maybe my PSA is going up! It was done about 6 weeks ago most recently. I'm beginning to think I might be fine.
Good point - I'm slowly getting there - have to work through physician first and physiotherapist - and then see where we go from there if we hit up the oncologists. I'm almost 20 months into this and beginning to figure out how to get things done. And basically there's no one there it's going to coach you on this. Health Unlocked MC is an important resource in many dimensions.
I have a practical suggestion. Go to your Cdn. drugstore ASAP and buy KT tape for about $40 CAD. Put 1-3 strips on the painful areas. If it's a muscular issue than this tape will cause you to feel better immediately. All I can say is that it is like magic - recommended from personal experience.
I can only relate my experience to you. After about two tears of constant muscular pain related to hip replacement surgery in 2021, I applied the KT tape about 3 weeks ago - like you I had been skeptical of its benefit. The result was almost instantaneous - I could walk without pain and without a limp. Your downside is $40!
🌻😃🎉 Pleased to report that 3 weeks after I experienced severe right hip pain (and, I didn't bother to mention, also left knee) all these pains seem to have gone away and I am back pursuing my heavy exercise program!
I still have this coming week an appointment with a physiotherapist and separately an x-ray and ultrasound. My goal is to understand how I can avoid debilitating injuries in the future.
In this case, the answer to the "Pain - is it muscle or met?" question is thankfully muscle! But there was a lot of fear along the way.
The comments in this forum discussion were very helpful in understanding how to distinguish between pain stemming from muscle and pain stemming from mets, especially bone mets.
A lot of us will probably run into this question. My original motivation for sharing my situation on the Forum was because I found the surprise arrival of pain to be very discouraging. It was tempting to give in to fear that maybe "this was it" - progression!
Fighting metastatic prostate cancer I've come to believe is sort of like walking on a tightrope. You can live as long as you don't fall off the tightrope - but if you suffer an injury and are not able to exercise every day and do the other things that are part of your regime, then one may be vulnerable to a cascade of destructive body processes. I've come to the conclusion that staying on the tightrope means discipline around exercise, sleep, diet etc. (That's my metaphor - I think most of us probably have some version of this kind of thing - at least the ones who are pursuing life extension and not only quality of life now. And of course, there's no guarantee.)
Now I'm keeping a pain diary now so in the future when something happens again I can refer back. And hopefully worry less.
And I'm back to exercise! Back on the tightrope! Pursuing high-volume and intense exercise in support of continuous suppression of mets. Maybe this will help slow progression. So that one can live more. For family, for work, for engaging in the world we are given.
My dad has been feeling pain for about the last month in random areas which I wouldn’t typically associate with MPCa. He mentioned the back of his calves and ham strings as well as his shoulders occasionally (which is a more normal spot for Mets). He says he doesn’t feel it on his bones but just soreness. He finished chemo about two months ago (part of triplet therapy) and his second set of scans (bone scan and CT scan) will be happening at the end of December. He was quite active (walking 45 min plus everyday) however because the weather got colder and he started feeling sore he stopped. He also doesn’t take any pain meds for his pain (no Tylenol, Advil or aleve) I guess he’s worried about being dependent on it however from what I’ve been reading pain meds seem to be normal for MPCa? I am thinking he maybe needs to start back up on exercise with more focus on strength training. Praying it’s not progression and also wondering if I should have scans scheduled sooner …
How about magnesium? I take extra magnesium (but not the citrate type) and it keeps the cramps at bay. Peter Attia has recently done another item on how magnesium is great for a lot of stuff. And it's not one of those supplements that are easy to overdose that one that I've heard. Is your Dad taking magnesium?
all I’ve been told is that if the pain goes to the groin it’s a hip issue. I walked around with pain in my left hip for a year thinking it was a hip replacement candidate. It was bursitis. We always think the worst. Cortisone shot no pain for a year.
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Muscle Pain.
Hip pain
Muscle pain from ADT
Bone Met Pain and Acupuncture
